Information Collection

Pre-Test 1 (Parents of youth ages 13-17) Cognitive Interview Screening

IC 250641 under ICR 202208-0920-008 · OMB 0920-1356.

Documents and Forms

Document Name Document Type
Pre-Test 1 (Parents of youth ages 13-17) Cognitive Interview Screening Form and Instruction
Cognitive interview screening Attachment S_Cognitive Interview Screener.docx Form and Instruction
Cognitive interview screening Attachment S_Cognitive Interview Screener.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Pre-Test 1 (Parents of youth ages 13-17) Cognitive Interview Screening	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	Cognitive interview screening	Attachment S_Cognitive Interview Screener.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	4	4
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.